上腹部脏器解剖腹膜和胃new 2

1、The peritoneum and the abdominal organs 1腹膜及腹腔脏器（1）主讲：许杰华E-mail: 西安交通大学医学院人体解剖与组织胚胎学系Outline 讲授大纲?概述Introduction?腹壁层次The layers of the abdominal wall?腹壁的重要局部 The important regions of abdominal wall?腹腔、腹膜及腹膜腔 Abdominal cavity, peritoneum and peritoneal cavity?腹腔重要脏器局解 The important organs of abdomina

2、l cavity胃； 肝脏；肝外胆道；肾脏?腹腔、腹膜和腹膜腔(Abdominal cavity, Peritoneum and Peritoneal cavity)?基本概念：?腹腔?腹膜（壁腹膜和脏腹膜）?腹膜腔腹膜腔?The introduction of the peritoneum?DefinitionThe peritoneum is a thin serous membrane that lines the walls of the abdominal and pelvic cavities and cover the organs within the two cavities

3、?Subdivisions and peritoneal cavity?Parietal peritoneum 壁腹膜lines the walls of the abdominal and pelvic cavities?Visceral peritoneum 脏腹膜covers the organs?Peritoneal cavity 腹膜腔the potential space between the parietal and visceral layer of peritoneum. Is there any organs inthe peritoneal cavity?The per

4、itonitis is very commonfor female!For male, it is a closed sac. But for female, there is a communication with the exterior through the uterine tubes, the uterus, and the vagina.?Function? Secretes a lubricating serous fluid that continuously moistens the associated organs? Support and protect viscus

5、? Semipermeable membrane (Peritoneal dialysis)? Absorption?The relationship between viscera and peritoneum Intraperitoneal visceraInterperitoneal visceraRetroperitoneal viscera?Intraperitoneal viscera 腹膜内位器官viscera completely surrounded by peritoneum, example, stomach, superior part of duodenum, jej

6、unum, ileum, cecum, vermiform appendix, transverse and sigmoid colons, spleen and ovary?Interperitoneal viscera 腹膜间位器官most part of viscera surrounded by peritoneum, example, liver, gallbladder, ascending and descending colons, upper part of rectum, urinary bladder and uterus?Retroperitoneal viscera

7、腹膜外位器官some organs lie on the posterior abdominal wall and are covered by peritoneum on their anterior surfaces only, example, kidney, suprarenal gland, pancreas, descending and horizontal parts of duodenum, middle and lower parts of rectum, and ureter?Structures formed by peritoneum ?Omentum 网膜The f

8、old of peritoneum that extends from two curvatures of stomach to adjacent organs ? Lesser omentum 小网膜two-layered fold of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenum.? Greater omentum大网膜大网膜four-layered fold of peritoneum, the anterior two l

9、ayers descend from the greater curvature of stomach and inferior part of duodenum and hangs down like an apron in front of coils of small intestine, and then turns upward and attaches to the transverse colon. Lesser omentumGreater omentum?Mesenterium 系膜two-layered fold of peritoneum that attach the

10、abdominal or pelvic organs to the posterior abdominal wall. mesenterium?Mesentery肠系膜肠系膜suspends the small intestine from the posterior abdominal wall?Broad and a fan-shaped ?Intestinal borderfolded, 5-7 m long?Radix of mesentery?15 cm long?Directed obliquely from left side of L2 to in front of right

11、 sacroiliac joint?Mesoappendix 阑尾阑尾系膜系膜?Triangular mesenteriumextends from terminal part of ileum to appendix?Appendicular artery runs in free margin of the mesoappendix ?Transverse mesocolon横结肠系膜a double fold of peritoneum which connects the transverse colon to the posterior abdominal wall?Sigmoid

12、mesocolon 乙状结肠系膜inverted V-shaped, with apex located in front of left ureter and division of common iliac artery?Ligaments 韧带?Ligaments of liver?Falciform ligament of liver 镰状韧带镰状韧带?Consists of double peritoneal layer ?Extends from anterior abdominal wall (umbilicus) to live?Free border of ligament

13、has ligamentum teres ?Coronary ligament 冠状韧带it is formed by the peritoneum between the diaphragm and the liver. There are left and right coronary ligament?Left and right triangular ligaments 左、右三角韧带formed by the left and right extremity of coronary ligament ligament, respectively?Hepatogastric ligam

14、ent 肝胃韧带?Hepatoduodenal ligament 肝十二指肠韧带?Extends from porta hepatis to superior part of duodenum?Contains common bile duct, proper hepatic a. and hepatic portal v.?Ligaments of spleen?Gastrosplenic ligament 胃脾韧带胃脾韧带a double layer of peritoneum that connects the fundus of stomach to hilum of spleen.

15、In this double layer of peritoneum, there are the short gastric and left gastroepiploic vessels?Splenorenal ligament 脾肾韧带extends between the hilum of spleen and anterior aspect of left kidney. The splenic vessels lies within this ligament, as well as the tail of pancreas?Phrenicosplenic ligament 膈脾韧

16、带?Ligaments of stomach?Hepatogastric ligament 肝胃韧带肝胃韧带?Gastrosplenic ligament 胃脾韧带胃脾韧带?Gastrophrenic ligament 胃膈韧带胃膈韧带?Gastrocolic ligament 胃结肠韧带胃结肠韧带?Gastropancrestic ligament胃胰韧带胃胰韧带?Folds, recesses and fossa皱襞、隐窝和窝?Superior duodenal fold and recess 十二指肠上襞和上隐窝?Inferior duodenal fold and recess 十二指

17、肠下襞和下隐窝?Intersigmoid recess乙状结肠间隐窝formed by the inverted V attachment of sigmoid mesocolon ?Hepatorenal recess 肝肾隐窝肝肾隐窝lies between the right lobe of liver, right kidney, and right colic flexure, and is the lowest parts of the peritoneal cavity when the subject is supine? Median umbilical fold 脐正中襞c

18、ontain the remnant of urachus (median umbilical ligaments)? Medial umbilical fold脐内侧襞contains remnants of the umbilical arteries (medial umbilical ligaments)? Lateral umbilical fold 脐外侧襞contains the inferior epigastric vessels? Supravesical fossa 膀胱上窝? Medial inguinal fossa 腹股沟内侧窝? Lateral inguinal

19、fossa 腹股沟外侧窝?Pouches陷窝?In malerectovesical pouch 直肠膀胱陷窝直肠膀胱陷窝?In female ?Rectouterine pouch(Douglas,cavity)直肠子宫陷窝between rectum and uterus ?Vesicouterine pouch 膀胱子宫陷窝between bladder and uterus ?Omental bursa 网膜囊Position situated behind the lesser omentum and stomachWalls?Superior peritoneum which co

20、vers the caudate lobe of liver and diaphragm?Anterior formed by lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentum?Inferior conjunctive area of anterior and posterior two layers of greater omentum?Posterior formed by posterior two layers of greater om

21、entum, transverse colon and transverse mesocolon, peritoneum covering pancreas, left kidney and suprarenal gland?腹膜腔的分部腹膜腔的分部 The subdivision of the peritoneal cavity (two sacs)?Leftformed by the spleen, gastrosplenic ligament胃脾韧带and splenorenal ligament 脾肾韧带?Rightformed by omental foramenOmental fo

22、ramen 网膜孔网膜孔?Behind the right border of hepatoduodenal ligament?Superiorcaudate lobe of liver ?Inferiorsuperior part of duodenum?Anteriorhepatoduodenal ligament?Posteriorperitoneum covering the inferior vena cavaThe Omental bursa (lesser sac) communicates with the greater sac through the omental for

23、amen.?The subregions of the peritoneal cavity?The transverse colon and transverse mesocolon divides the peritoneal cavity into supracolic and infracolic compartments . 结肠上区和结肠下区Supracolic compartment结肠上区(subphrenic space) lies between diaphragm and transverse colon and transverse mesocolon Suprahepa

24、tic recess 肝上间隙lies between the diaphragm and live the falciform ligament divides it into right and left suprahepatic recesses?Left suprahepatic space左肝上间隙?left anterior suprahepatic space?left posterior suprahepatic space?Right suprahepatic space右肝上间隙?Subphrenic extraperitoneal space膈下腹膜外间隙(corresp

25、onding to the bare area of liver) Infrahepatic space 肝下间隙lies between the live and transverse colon and transverse mesocolonthe ligamentum teres hepatic divides it into right and left infrahepatic spaces?Right infrahepatic space 右肝下间隙(hepatorenal recess)?Left infrahepatic spaces 左肝下间隙?left anterior

26、infrahepatic space?left posterior infrahepatic spaceInfracolic compartment结肠下区lies below the transverse colon and transverse mesocolon ?Right paracolic sulcus(gutter) 右结肠旁沟lies lateral to the ascending colon. It communicates with the hepatorenal recess and the pelvic cavity. It provides a route for

27、the spread of infection between the pelvic and the upper abdominal region.?Left paracolic sulcus (gutter) 左结肠旁沟lies lateral to the descending colon. It is separated from the area around the spleen by the phrenicocolic ligament, a fold of peritoneum that passes from the colic flexure to the diaphragm

28、.?Right mesenteric sinus右肠系膜窦triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon and transverse mesocolon?Left mesenteric sinus左肠系膜窦lies between root of mesentery, descending colon, left 1/3 of transverse colon and transverse mesocolon, its widens below w

29、here it is continuous with the cavity of the pelvis? The organs of the abdominal cavity 腹腔脏器：?Supracolic compartment结肠上区?Infracolic compartment结肠下区结肠下区?Extraperitoneal space 腹膜后间隙结肠上区脏器解剖结肠上区脏器解剖?胃的局解?肝脏的局解?肝外胆道的局解?胃的局解（Anatomy of stomach）?形态和分部Features and divisions?位置和毗邻Position and relationship?胃的网膜和韧带Omentum and Lig